Modified Marionette Technique for Laparoscopic Colorectal Surgery

Introduction: Single-port laparoscopic surgery has some technical limitations with respect to control of the forceps inserted through the single-access site, which results in increased internal collisions due to coaxial alignment of the instruments, as well as and decreased range of motion and visualization. To overcome these limitations, we employ a "modified marionette technique" as a way to carry out laparoscopic colorectal surgery. Materials and Surgical Technique: The procedures for the modified marionette technique are performed as follows: An Internal Organ Retractor (IOR)™ and an atraumatic clip designed to firmly grasp tissue, with 1-0 nylon thread, are inserted through a 12-mm trocar and secured in place where adequate visualization and traction for cutting with a radio knife is required. A looped 1-0 nylon thread put through an 18-gauge injection needle is pierced through the abdominal wall, the looped nylon extruded, and the nylon attached to the IOR is pulled out by threading the looped nylon thread. This allows for adequate traction from outside the body through the abdominal wall and appropriate placing adjustments. Conclusion: The "modified marionette technique" using IOR introduced here is an easy, economical, effective and safe traction technique for colorectal surgeries. This technique will be a useful tool for performing both reduced port and multiport laparoscopic colorectal surgeries.